HbA1c testing in the community pharmacy: A new strategy to improve care for patients with diabetes

Papastergiou, John; Rajan, Amy; Diamantouros, Artemis; Zervas, John; Chow, Justin; Tolios, Peter

doi:10.3821/145.4.cpj165

Cited by 12 publications

(14 citation statements)

References 6 publications

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“…The mean HbA1c was very high in our patients, which clearly demonstrated the poor control of diabetes mellitus in our patients. In a Canadian study [8] done by pharmacists, the mean HbA1c was found to be 7.25%, and 43.6% of patients had HbA1c values of over 7%,…”

Section: Resultsmentioning

confidence: 97%

Diabetic Profile- Screening of HBA1C - A Random Community Assessment

Suchitra

Jaiganesh²,

Parthasarathy³

2013

JCDR

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IntrOductIOnDiabetes Mellitus (DM), often referred to as diabetes-is a condition in which the body either does not produce enough insulin, or does not properly respond to insulin. This leads on to hyperglycaemia, which is the basic cause of systemic complications associated with the disease. Strict control of blood sugar remains the pivot in the decreased incidence of complications [1]. Glycated haemoglobin or A1C should be measured in all individuals with DM during their initial evaluation and as part of their comprehensive diabetes care [2]. It is the primary predictor of long-term complications of DM [3]. In the normal 120 day life span of the RBCs, glucose molecules react with Hb, forming glycated Hb. Measuring HbA1c can reveal as to how high the blood glucose has been on an average, over the past 8-12 weeks. A normal non-diabetic HbA1c value is 3.5-5.5%. In diabetics, range of 6.5% to 7% is good. In individuals with poorly controlled diabetes, the quantity of this glycated Hb is much higher than in healthy people. A build up of glycated Hb within the red blood cells, therefore, reflects the average level of glucose to which the cells have been exposed during their life cycle. The glycaemic goal is to achieve an A1C as close to normal as possible, without developing significant hypoglycaemia. In general, the target A1C should be <7.0% with a more stringent target (<6%) for many patients. A higher A1C goal may be appropriate for the very young or old or in individuals with limited life spans or comorbid conditions [4]. The major consideration is the frequency and severity of hypoglycaemia, since this becomes more common with a more stringent A1C goal. The advantages of doing HbA1C assessment are non-requirement of fasting, with fewer perturbations with stress, diet and exercise. It captures the chronic hyperglycaemia better than fasting glucose levels. The analytical variability is similar with estimation of blood glucose community Section levels [5]. With this background, we made a random assessment of HbA1C in a sample diabetic population, using clinical questionnaire on complications. Such simple data collections with their analysis for the South Indian population are not available much. aim 1. To find out the control of diabetes in randomly selected patients of a community in a given time.2. To find out the clinical incidence of target organ damage in terms of a vascular event.3. To find out the incidences of hypoglycaemic episodes and their correlations with HbA1C levels.4. To estimate the prevalence of risk factors like smoking and obesity. MAterIAl And MethOdsA simple observational study was conducted on diabetic patients at the diabetic centre in Kumbakonam, Southern India. The first 100 semi-urban diabetic patients who came to two nearby private clinics with similar treatment concepts in one day were taken up for the study. They were subjected to a simple questionnaire and a random HbA1c level was estimated after getting their consents. No ethical issues were involved, as the study was basically abou...

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Section: Resultsmentioning

confidence: 97%

Diabetic Profile- Screening of HBA1C - A Random Community Assessment

Suchitra

Jaiganesh²,

Parthasarathy³

2013

JCDR

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“…A1c analysis was performed using the Bayer A1c Now meter as described previously [11]. Methods of patient recruitment and approach to A1c screening clinics were at the discretion of the participating pharmacies and were not standardized; however, in general, A1c clinics proceeded as we reported previously [11].…”

Section: Methodsmentioning

confidence: 99%

“…[11] Methods of patient recruitment and approach to A1c screening clinics were at the discretion of the participating pharmacies and were not standardized; however, in general, A1c clinics proceeded as we reported previously. [11] Briefly, after performing the A1c finger stick test, the pharmacist conducts a medication review and performs an assessment of blood pressure, glycaemic control (including review of A1c results), lifestyle habits and the possible development of diabetes-related complications. Based on the results of the assessment, interventions and recommendations are made by the pharmacist in accordance with the 2008 CDA guidelines.…”

Section: Methodsmentioning

confidence: 99%

“…It is noteworthy that the vast majority of these studies have been small cohort studies based in clinical (non‐retail) settings such as primary care clinics. We previously described our experiences and results in providing community‐based A1c screening at three Shoppers Drug Mart retail pharmacy locations in Toronto, Ontario [11]. Our initial experiences suggested that community pharmacists in a retail setting can play an important role in providing accessible disease monitoring, identifying opportunities for intervention in cases of poor glycaemic control and assisting patients in taking steps to improve their glycaemic control.…”

Section: Introductionmentioning

confidence: 99%

“…We previously described our experiences and results in providing community-based A1c screening at three Shoppers Drug Mart retail pharmacy locations in Toronto, Ontario. [11] Our initial experiences suggested that community pharmacists in a retail setting can play an important role in providing accessible disease monitoring, identifying opportunities for intervention in cases of poor glycaemic control and assisting patients in taking steps to improve their glycaemic control. Since this pilot project, the A1c screening initiative has expanded nationally across the Shoppers Drug Mart network, which includes over 1200 retail pharmacy locations.…”

Section: Introductionmentioning

confidence: 99%

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Community pharmacy-based A1c screening: a Canadian model for diabetes care

Papastergiou

Folkins²,

Li³

2015

International Journal of Pharmacy Practice

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Integrating Rapid Diabetes Screening Into a Latinx Focused Community-Based Low-Barrier COVID-19 Testing Program

Kerkhoff

Rojas²,

Black

et al. 2022

JAMA Netw Open

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IMPORTANCE Community-based COVID-19 testing and vaccination programs play a crucial role in mitigating racial and ethnic disparities in COVID-19 service delivery. They also represent a platform that can be leveraged to expand access to testing for chronic diseases, including diabetes, that disproportionately affect the Latinx community and other marginalized communities. OBJECTIVETo evaluate outcomes associated with a diabetes testing strategy designed to reach low-income Latinx persons by leveraging COVID-19 testing infrastructure and community trust developed during the COVID-19 pandemic. DESIGN, SETTING, AND PARTICIPANTS This health care improvement study was conducted from August 1 to October 5, 2021, at an outdoor, community-based COVID-19 testing site at a transport hub in the Mission Neighborhood in San Francisco, California. Because the program was designed to expand access to diabetes screening to the local community, all individuals presenting for on-site testing were eligible. Data were analyzed in November 2021. INTERVENTIONS Integration of rapid, point-of-care hemoglobin A 1c screening as a testing option in an existing low-barrier COVID-19 testing program. MAIN OUTCOMES AND MEASURES Evaluation was guided by the Reach, Effectiveness, Adoption, Implementation and Maintenance (RE-AIM) framework and utilized programmatic data and structured surveys among clients and staff. RESULTSOf 6631 individuals tested (median [IQR] age 39.3 [29.7-51.3] years; 3417 [52.3%] female, 4348 [65.6%] Latinx), 923 (13.9%) underwent hemoglobin A 1c testing with or without COVID-19 testing and 5708 (86.1%) underwent COVID-19 testing only. Individuals tested for diabetes were more likely to be Latinx (763 of 923 individuals [82.7%] who underwent testing were Latinx vs 3585 of 5708 [62.8%] not undergoing testing), have an annual household income of less than $50 000 (450 individuals [81.2%] vs 2409 individuals [66.0%]), and not have health insurance (381 individuals [47.2%] vs 1858 individuals [39.9%]), and 206 (48.0%) had never tested for diabetes before. Overall, 313 (33.9%) and 113 (12.2%) individuals had prediabetes and diabetes, respectively;only 141 of 354 of these individuals (39.8%) had a primary care clinician whom they had seen in the prior 12 months, which was lower among Latinx individuals (113 of 307 individuals [36.8%] vs 28 of 47 [59.6%]). Acceptability of the rapid testing program was high-98% were satisfied with their visit and 96% said they would return for future services; key factors underpinning acceptability included friendly staff, efficiency, and a convenient location. (continued) Key Points Question Is integrating rapid diabetes screening into a community-based COVID-19 testing site feasible and effective in reaching socioeconomically disadvantaged Latinx persons without health care? Findings In this health care improvement study of 6631 participants presenting for COVID-19 testing, 923 (13.9%) underwent hemoglobin A 1c testing, of which 313 (34%) and 113 (12%) had prediabetes and diabetes, respectively...

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HbA1c testing in the community pharmacy: A new strategy to improve care for patients with diabetes

Cited by 12 publications

References 6 publications

Diabetic Profile- Screening of HBA1C - A Random Community Assessment

Diabetic Profile- Screening of HBA1C - A Random Community Assessment

Community pharmacy-based A1c screening: a Canadian model for diabetes care

Integrating Rapid Diabetes Screening Into a Latinx Focused Community-Based Low-Barrier COVID-19 Testing Program

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